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Monthly Archives: November 2017

Dr Elspeth Whitby reflects on the changing shape of her clinical practice, after a research project and the curation of an exhibition which has opened up new ways to engage the public with her work and medical imaging.

This month I am involved in the launch of a new exhibition, Remembering Baby: Life, Loss and Post-Mortem which opens in London (3-14 November 2017) and then in Sheffield (5-14 December 2017). The exhibition is a result of the “‘End of’ or ‘Start of’ Life’” research project which explores how Magnetic Resonance Imaging (or MRI) techniques are starting to be applied to post-mortem practice – including pregnancy loss and neonatal death. This is an important initiative as it is a technique which is less invasive and arguably less distressing for all involved.

This interdisciplinary collaboration has provided an insight into aspects of my work as a radiologist that I would never normally be aware of, and it has highlighted the importance of understanding parents’ needs at a time when they may be anxious, upset, stressed, concerned and affected by a whole range of emotions. I have learnt how ‘little’ things mean so much to families who experience baby loss, and that these can have a huge impact on how they live with their child’s death.

Making visible the often hidden care practices enacted by health professionals who look after babies and their families following a foetal or neonatal death, is a key aim of the Remembering Baby exhibition. Our research team has worked in collaboration with the BIR artist in residence, Hugh Turvey and sound artist Justin Wiggan, to create exhibits related to early-life loss.

Remembering Baby seeks to make these encounters more visible and features a collection of visual images, physical objects and sound installations that sensitively explore what happens when a baby dies, from both parental and professional perspectives. By talking with Hugh about our study, he has been able to interpret and creatively represent some key themes and findings from the research – including MRI’s role in the developing landscape of minimally invasive post-mortem for babies. In the pieces there is also a broader focus on care practices and memorialisation.

As part of the research project we ran a Lasting Impressions workshop. We invited bereaved parents and relatives from the local area to bring along items that were precious to them and related to their baby. The individuals who came were amazing. They talked very openly to us and to each other about their babies and the memory objects they had bought. Guided by Hugh the participants made paper impressions and rubbings of their items and donated their work to us for the exhibition. Those that came to the workshop were at different stages of their bereavement – for some the loss was very recent, for others it was many years ago – and they all had very different experiences. There was not a single person in the room who did not have tears in their eyes at some point during the workshop, but they were not all sad tears.

It made me realise that as professionals we have improved greatly over the years in terms of how we include families in decision-making and with regard to the support we provide, but we can still do more. During the workshop a parent shared how one item held sad memories for her because it was associated with seeing a spot of blood on her child’s Babygro as they were preparing for the memorial service. This is something I will never forget, and something that could have been avoided. I now look at things in detail beyond the medical side, and consider if there is there anything more we can do to ensure that we avoid additional sadness however small it seems.

In my blog The Role of a Radiologist when a Baby Dies I mentioned the difference between what I understood by the question “what happens to my baby?” and what the parent really wanted to know. We now have leaflets in all our patient packs explaining who looks after the baby, who dresses it, cares for it and where. The midwives have the information for parents when they ask and some of the uncertainties have been removed.

Volunteers have been linked with professionals and support groups so that the items they create meet the needs of all these groups.
Where next? We plan to run educational events for health professionals and support groups, and to continue to work in collaboration and extend our work to looking at consent.

Throughout my career I have been taught that experience is the most important learning tool. This work has highlighted that it is not just the medical experience but my journey with each individual patient, what their needs are and what they can teach me for my future interactions with other patients and relatives.

This project is funded by the Economic and Social Research Council (ESRC) and is a close collaboration with colleagues in Sociological Studies at the University of Sheffield – Kate Reed (project lead) and Julie Ellis (researcher)

Images courtesy of Hugh Turvey

Dr Elspeth Whitby is a senior lecturer at the University of Sheffield and an honorary consultant at Sheffield teaching Hospitals NHS Foundation trust. Her clinical and research interests are based around MR Imaging of the foetus and neonate. She provides a national service for foetal MRI and is an integral part of the team at Sheffield Children’s hospital, which has set up the world’s first clinical service for minimally invasive autopsy for the foetal and neonatal age group. Her research provides the necessary data to assess the value of new MRI techniques and then to support the transitions from research to service. The multidisciplinary nature of her more recent work is changing her as well as influencing clinical practice.

She was the ex-Vice President for Education at the BIR. Whilst in this role Elspeth helped to improve the educational scope and methods of delivery of educational events for all BIR members.

High quality and safe care is a must for our patients. But what should health professionals do if they witness a situation that puts a patient at risk? Heather Bruce, Diagnostic Radiographer, explains how her role as a “Freedom to Speak Up Guardian” enables staff to raise concerns and how it contributes to an open culture at her trust.

I have worked as a Diagnostic Radiographer for a long time in The University Hospitals of Morecambe Bay National Health Service Foundation Trust (UHMBT)–knocking along happily in plain film imaging; then about four years ago I was elected Industrial Relations Representative for the Society of Radiographers and that change increased my interest in quality and safety of patient care through supporting staff.

Robert Francis’ public inquiry into the Mid-Staffordshire scandal exposed how patient care was neglected, by focussing on performance targets and the goal of achieving Foundation Trust Status at the expense of safety, and it was apparent that those staff who had raised concerns there were treated very badly. Francis was commissioned to carry out the Freedom to Speak Up (FTSU) review, published February 2015, where he found that that victimisation of whistle-blowers has been widespread throughout the NHS. This history is well known among NHS staff and makes them very reluctant to raise concerns for fear of reprisals, and not speaking up endangers our patients.

The Government accepted all of the recommendations of the Freedom to Speak Up (FTSU) review one of which was to have a FTSU Guardian in every Trust to support staff to speak up.

UHMBT board closely followed the recommendations of the FTSU review; so they advertised for someone who was clinically professional and with a background of management (governance or staff side) ensuring that the FTSU Guardian was accessible to all. I was very interested in the potential of this post and it also enabled me to continue to practise professionally. I was appointed in July 2015 and became one of the first FTSU Guardians in the country. It is always challenging to start in a new post but especially when the job was not there before. There was no training available and the only guidance available was in the FTSU review which I found inspirational.

The job has evolved and expanded to more than three days a week and it is divided into being proactive and reactive. The promotion of a culture where speaking up is normal everyday practice is very time consuming, especially in our geographically challenged trust–Morecambe Bay sits right in the middle of UHMBT.

One of the problems in promoting FTSU is that frontline staff do not have time to access the intranet for Trust communications while they are working. More staff saw a recent article in the local press than read it in the Trust communications. Even though it is time consuming, walkabouts are still the best way to raise awareness and I continue to do them regularly. I also do all the induction sessions for new staff, students and apprentices. I attend as many networks and audit meetings as possible to get the message out there.

(Image: Promoting speaking up as everyday practice in Furness General Radiology Dept)

As a radiographer I am keen on using innovative technology and UHMBT was the first Trust to have the “Freedom to Speak Up App” which makes it is very easy to speak up–staff may not read Trust communications but they often have their phones on them!
FTSU doesn’t come about overnight or in isolation, and has to be part of an open and transparent culture that values its staff and patients. The best performing Trusts have the highest rate of reporting of clinical incidents and similarly you would expect concerns to be raised and welcomed for patient safety.

When someone has a concern that they think is not being addressed, or they are not sure how to raise it or who to raise it with, they then get in touch with me by a variety of means; email, text message, phone call, through the FTSU App or by direct approach. I usually meet up with them at a mutually agreed venue not necessarily on Trust premises–with 12,000 leaflets distributed across the Bay I am quite recognisable and not everyone wants to be seen meeting with me by their colleagues etc! After establishing the nature of the concern we agree how to escalate it and then it is a case of checking that it is addressed appropriately – with follow-up and feedback.

I meet with the Lead Non-Executive Director for FTSU and the Medical Director every month to discuss the concerns that are being raised, themes that may be identified and any issues in getting the concerns addressed. All concerns are treated confidentially and if staff do not wish to be named, that is usually possible except if it is required for legal purposes.

However, change can be slow to embed and the promotion of speaking up is a never-ending task. I am confident that I have the full support of the Board and any concerns that I flag up with Directors are always promptly responded to.

I am pleased to say that I have been contacted by a range of staff from volunteers, governors (non-clinical and clinical), to consultants; feedback has been good and staff seem to feel that their concerns have been listened to and addressed. One of the things I have noticed is how much staff value being kept informed so that they know that they haven’t been forgotten or ignored.

Nationally I enjoy networking with my fellow FTSU Guardians, and the newly established National Guardian’s Office is supportive.

This is an unusual role for a radiographer but I understand that there are four or five of us now across the UK. Diagnostic Radiographers work in a range of departments in hospitals, so that gives us an ease of access that has been really useful.

Recently I was lucky enough to be asked to speak at the National Radiology Managers conference and that was a great opportunity to promote speaking up and the suitability of radiographers to other roles within the NHS–all linked to high quality patient care.
This can be a difficult role but it is rewarding as there have been obvious improvements in patient safety and staff are really pleased that someone will make sure that their concerns are listened to and acted on. We know the FTSU campaign is working as concerns have continued to be raised.

The aim of the FTSU campaign is to make sure everyone who works in the NHS feels able to speak up for our patients’ safety–patients are vulnerable and it is our duty to be alert for them.

We will all be patients one day-and FTSU is part of ensuring that everyone experiences the high quality safe care that we are all entitled to.

If you would like any more info on FTSU in University Hospitals of Morecambe Bay NHSFT then please don’t hesitate to contact Heather on heather.bruce@mbht.nhs.uk or on 07890 587013

The government has accepted all the recommendations of the FTSU and so there will be opportunities for posts in all Trusts